Gregory Landry, MD is an Assistant Professor of Surgery, Division of Vascular Surgery at the Oregon Health & Science University (OHSU). Dr. Landry's long term objective is to establish a Center for Functional Outcomes in Vascular Surgery at OHSU. This proposal describes a plan to develop Dr. Landry into an independent clinical researcher. A three-tiered mentored career development plan is proposed, including 1) a didactic education resulting in a Masters in Clinical Research (MCR), 2) a broad-based experiential learning program, and 3) a mentored clinical research project. Mentored clinical research will be under the guidance of a mentorship advisory committee headed by Dr. Lloyd Taylor, Professor of Surgery at OHSU, and including Dr. Gregory Moneta, Professor of Surgery at OHSU, Dr. Cynthia Morris, Professor of Medical Informatics and Outcomes Research at OHSU, and Dr. Mary McDermott, Associate Professor of Medicine at Northwestern University. The proposed research focuses on functional outcomes of patients undergoing treatment for critical limb ischemia (CLI). The hypothesis that patients undergoing surgery for CLI derive significant functional benefit that is superior to nonoperative therapy will be examined. Specific aims include prospectively evaluating the functional outcome of patients undergoing surgery for CLI, the current standard of care, with a battery of functional outcome and quality of life assessments. An additional specific aim is to perform a randomized, prospective trial of surgical versus nonsurgical management of patients with CLI to determine which provides optimal functional outcome. This study is important in that optimal treatment of lower extremity ischemia has not been clearly defined in a randomized setting, and the population of patients in the United States with CLI is expected to increase with the aging of the population. The TransAtlantic Intersociety Consensus, an international consortium of physicians involved in the management of peripheral arterial disease, has identified patient-oriented outcome research in CLI as an area of "critical need."